Unchanged cervical MRI--(redwings?)

[lemstar]

I have been having pain in my arms and fingers, as well as a feeling of fatigue in my arms and hands. My MS specialist sent me for cervical MRI, with and without contrast, and the radiologist reports no change since last April (there is a cervical lesion that hasn't changed). My PCP called me with the results of the report, all exuberant and happy, "Whatever those symptoms you are having are, they are NOT MS!".
Well, I am not so sure. It's worse on my more affected side, and the fatigue feeling seems MS-y. I haven't spoken with the MS specialist, as he wants to see the MRI films, and they have just been sent (he is over an hour away). I also have arthritis in my neck, but it is also unchanged, and I don't have neck pain, or restriction of movement. As I type, my fingers are exhausted. I don't know what to think. My PCP stated that MS isn't usually associated with pain. I told him I thought otherwise. I will talk to the MS specialist this week probably, but in the meantime, I am wondering--is this a flare? Is it just the manifestation of my MS?
I am not on any DMD. My MRIs haven't changed in over two and a half years. I have had MS for 31 years, with little progression, and mostly sensory symptoms.
Anyone have any thoughts? Thanks!

[salamandertom]

I had a c-spine MRI in Dec 2010, I just had a repeat in Nov 2011. I had one only the MS specialist could see in 2010, now I have three distinct lesions. I had this last one b/c I was having "heavy legs" with difficulty walking. My lesions were not enhancing.

I asked her at my appointment (which was this past Friday) what exactly that meant. She said that enhancing lesions are lesions that are new and are actively inflaming. I asked her if it would pick it up every single time and she said, that it would not - that we had done the MRI too late and that we just hadn't "caught" them.

Basically the lesion in your spine can and will probably continue to give you symptoms - even if it is not bigger or enhancing. Apparently the old lesions will not enhance, even when getting bigger (my understanding anyhow - please someone correct me if I am wrong.). THey can and have seen this in some cases, but it is not typical.

For your neuro to say that whatever is wrong is NOT ms baffles me to be honest. I really would rethink continuing care with this doctor honestly. Not only do I think he is wrong, but for him to be excited about that statement is just upsetting.

I am still pretty new to this, so hopefully someone else will come on and respond. HUGS and good luck.

[lemstar]

Thanks for your reply. Please note it wasn't my neuro who said it wasn 't MS, it was my PCP. I haven't yet spoken with my MS specialist as I am waiting til he gets the actual films to see for himself. I do believe there was no enhancement evident, so I guess at least I am not blaringly in the midst of a flare...
Would love to hear what anyone else might have to say?
Thanks!

[0485c10]

Spine lesions do not reliably pick up the dye in the spine. An unenhancing lesion in the spine may or may not be active. Can't be sure in the spine. from what i read spine tissue is denser than brain tissue and lesions are more difficult to see in spine tissue, so it makes sense that salamanfdertom wrote that only her ms specialist saw them on review of the mri. hope you get an explanation from your neuro when he/she sees the mri.

my doc told me when my feet became heavy and an mri of my neck showed no change in the 4 lesions there but my brain mri did show an active lesion, i had ON at the time, that a new lesion can cause old lesions to act up in ways not previously experienced. she thought my feet issue was from my neck lesions whether they showed a change on the mri or not. didn't matter what caused it, the ms treatment stayed the same & i didn't need anything else. a more definitive explanation on the mri would have been nice though.

[Redwings]

Hi lemstar:
I don't really have much to add. There isn't redundancy in the spinal cord (ways to route around damage), so spinal cord lesions (or other cord problems) don't tend to be "silent." Whether or not your symptoms represent a flare will have to be determined by your neurologist. Despite what the radiology report says, your MS specialist is doing the right thing by reading your MRIs himself and will be able to put your symptoms into context with what's on your MRI.

As the other posters mentioned, cord lesions can cause problems even if they're not evident on MRI. I've had two episodes of partial transverse myelitis with very large lesions, and I've been unbelievably fortunate in that both times the damage healed well enough that nothing is visible now on MRI (yeah, I know! ). But I still have lingering symptoms that go through phases. That fits with the guideline that cord problems aren't silent, even if they aren't enhancing, are unchanged or may not even show up on MRI.

I will add, though, that while your PCP is acting in the role of a PCP, it's apparent that he's just parroting back whatever he's read about MS and doesn't know enough about it to be advising you, or even commenting on your MS. For you own peace of mind, it might be better to pretend he never said anything about MS and deal only with your MS specialist as much as possible. You'll have to decide whether he's a good enough PCP to keep for primary care in spite of his MS gaffes.

If he is, you'll still have to deal with him, so -- again for your own peace of mind -- you may have to do some of the hard work for him and direct him to some educational resources about MS. You can print out articles and/or brochures about MS pain from the NMSS website (search for pain), and also request that he go to the NMSS website and access the information under "For Professionals." Even if you change to a different PCP who's better with MS and shows better judgment, you may still have to educate that doc about something.

Please do let us know what your MS specialist says.

[lemstar]

Thanks guys. Red, after my PCP told me pain isn't usually associated with MS, I did link some info to him re MS, and he was appreciative. I will wait til I talk to my MS specialist to further discuss the fact that an unchanged MRI doesn't mean I am cured and symptom free. Sheesh.
And I will let you all know what my neuro says.
Thanks again. This is the best source of real info there is....